TY - JOUR
T1 - Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment
AU - Geffen, Eline G.M.van
AU - Nederend, Joost
AU - Sluckin, Tania C.
AU - Hazen, Sanne Marije J.A.
AU - Horsthuis, Karin
AU - Beets-Tan, Regina G.H.
AU - Marijnen, Corrie A.M.
AU - Tanis, Pieter J.
AU - Kusters, Miranda
AU - Aalbers, Arend G.J.
AU - van Aalten, Susanna M.
AU - Amelung, Femke J.
AU - Ankersmit, Marjolein
AU - Antonisse, Imogeen E.
AU - Ashruf, Jesse F.
AU - Aukema, Tjeerd S.
AU - Avenarius, Henk
AU - Bahadoer, Renu R.
AU - Bakers, Frans C.H.
AU - Bakker, Ilsalien S.
AU - Bangert, Fleur
AU - Barendse, Renée M.
AU - Beekhuis, Heleen M.D.
AU - Beets, Geerard L.
AU - Bemelman, Willem A.
AU - Berbée, Maaike
AU - de Bie, Shira H.
AU - Bisschops, Robert H.C.
AU - Blok, Robin D.
AU - van Bockel, Liselotte W.
AU - Boer, Anniek H.
AU - den Boer, Frank C.
AU - Boerma, Evert Jan G.
AU - Boogerd, Leonora S.F.
AU - Borstlap, Jaap
AU - Braat, Manon N.G.J.A.
AU - Burghgraef, Thijs A.
AU - ten Cate, David W.G.
AU - Dekker, Jan Willem T.
AU - Goense, Lucas
AU - van Grevenstein, Wilhelmina M.U.
AU - den Hartogh, Mariska D.
AU - Hendriksen, Ellen M.
AU - van der Hoeven, Erik J.R.J.
AU - Intven, Martijn P.W.
AU - Ootes, Daan
AU - Plate, Joost D.J.
AU - van Trier, Dorothée
AU - Verschuur, Anna V.D.
AU - Zandvoort, Herman J.A.
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2024/6
Y1 - 2024/6
N2 - Background: Detection of grade 3–4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy. Methods: A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour ≤8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). Results: The 1213 included patients had a median follow-up of 48 months (IQR 30–54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, <0.001) and DM-risk (49% vs 30% vs 21%, p < 0.001) and decreased DFS (42% vs 55% vs 69%, p < 0.001) and OS (62% vs 76% vs 81%, p < 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM-rate was comparable to initial absence of mrEMVI (both 26%), whereas LR-rate remained high (22% vs 9%, p = 0.006). Conclusion: The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.
AB - Background: Detection of grade 3–4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy. Methods: A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour ≤8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). Results: The 1213 included patients had a median follow-up of 48 months (IQR 30–54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, <0.001) and DM-risk (49% vs 30% vs 21%, p < 0.001) and decreased DFS (42% vs 55% vs 69%, p < 0.001) and OS (62% vs 76% vs 81%, p < 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM-rate was comparable to initial absence of mrEMVI (both 26%), whereas LR-rate remained high (22% vs 9%, p = 0.006). Conclusion: The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.
UR - http://www.scopus.com/inward/record.url?scp=85189787176&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2024.108307
DO - 10.1016/j.ejso.2024.108307
M3 - Article
C2 - 38581757
AN - SCOPUS:85189787176
SN - 0748-7983
VL - 50
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 6
M1 - 108307
ER -